Area Health Service Research Articles

How ready is the system to deliver primary healthcare? Results of a primary health facility assessment in Enugu State, Nigeria.

Primary health centres are an effective means of achieving access to primary healthcare (PHC) in low- and middle-income countries. We assessed service availability, service readiness and factors influencing service delivery at public PHC centres in Enugu State, Nigeria. We conducted a cross-sectional study of 60 randomly selected public health centres in Enugu using the World Health Organization’s Service Availability and Readiness Assessment (SARA) survey. The most senior health worker available was interviewed using the SARA questionnaire, and an observational checklist was used for the facility assessment. None of the PHC centres surveyed had all the recommended service domains, but 52 (87%) offered at least half of the recommended service domains. Newborn care and immunization (98.3%) were the most available services across facilities, while mental health was the least available service (36.7%). None of the surveyed facilities had a functional ambulance or access to a computer on the day of the assessment. The specific-service readiness score was lowest in the non-communicable disease (NCD) area (33% in the rural health centres and 29% in the urban health centres) and NCD medicines and supplies. Availability of medicine and supplies was also low in rural PHC centres for the communicable disease area (36%) and maternal health services (38%). Basic equipment was significantly more available in urban health centres (P = 0.02). Urban location of facilities and the presence of a medical officer were found to be associated with having at least 50% of the recommended infrastructure / basic amenities and equipment. Continuing medical education, funding and security were identified by the health workers as key enablers of service delivery. In conclusion, despite a focus on expanding primary care in Enugu State, significant gaps exist that need to be closed for PHC to make significant contributions towards achieving universal healthcare, core to achieving the health-related Sustainable Development Goal agenda.

Decision-making processes of a nurse working in mental health, regarding disclosure of confidential personal health information of a patient assessed as posing a risk

Background Nurses working in mental health routinely face difficult decisions regarding confidentiality and disclosure of patient information. There is public interest in protecting patient confidentiality, and there is a competing public interest in disclosing relevant confidential information to protect the patient or others from harm. However, inappropriate disclosures may constitute a breach of confidentiality. Despite the gravity of this situation, there is a paucity of literature to guide nurses’ decision-making processes regarding confidentiality and disclosure. Aim To examine decision-making processes of a nurse working in mental health, regarding disclosure of personal health information of a patient assessed as posing a risk. Methods Qualitative interpretivist approach using thematic analysis of data derived from an instrumental case study of NK v Northern Sydney Central Coast Area Health Service 2010, a Civil and Administrative Tribunal matter in New South Wales, Australia. Findings Three important legal concerns relevant to nurses’ decision-making processes are illuminated. Firstly, for risk assessment there was an emphasis on a static notion of dangerousness. Secondly, rules of confidentiality and disclosure were not adequately observed. Thirdly, confidential information was disclosed without valid justification. Discussion Inappropriate decision-making processes that may lead to a breach of patient confidentiality were evident in the findings. Gaps in understanding nurses’ decision-making processes pertaining to confidentiality and disclosure of patient information that may be addressed by future research were also revealed. Conclusion Future research that addresses gaps in understanding nurses’ decision-making processes identified by this instrumental case study would provide greater guidance for nurses when making decisions regarding confidentiality and disclosure related to risk.

Influence of Patient Related Factors on Health Seeking Behaviours among Men with Lower Urinary Tract Symptoms attending Surgical Out Patient Clinic at Meru Level Five Hospital, Kenya

Background: Currently there are increased cases of men presenting with Lower Urinary Tract Symptoms (LUTS) especially in low resource countries. These symptoms may or may not be related to prostate cancer and health seeking behaviours are not clear. Purpose: To establish the influence of patient related factors on health seeking behaviours for Lower Urinary Tract Symptoms (LUTS) among men attending surgical outpatient clinic at Meru hospital, Kenya.Methods: Descriptive cross-sectional study design was used. The study population involved 120 men suffering from LUTS, 2 physicians and 2 nurses. Questionnaires and interview guides were used for data collection. Study period was from August 2018 to March 2020.Results: Majority (67.0%) of the patients with LUTS were aged between 61-70 years. Also, the majority (68.8%) of the respondents had primary level of education. The findings also pointed out majority (72.0%) of the patients were farmers with income level of below Ksh. 20,000. Logistic regression was used whereby P-values determine the statistical significance of results with cut off set at (p ?0.05). The inferential statistics pointed out that patient related factors test items had a statistical significant influence since the p-values were found to be less than 0.05 at 95% confidence interval. Conclusion: There was a significant negative influence of patient related factors such as lack of knowledge, low income levels and distance to health care facilities on health seeking practices. Therefore patients seek medical attention when quality of their lives has been threatened. The study recommends adopting measures of rising awareness on need for seeking early medical attention and initiate outreach health services in underserved areas or through telehealth

Role of physician density in predicting stage and survival for head and neck squamous cell carcinoma.

Identifying and linking barriers to access to head and neck cancer care, specifically provider density, to stage of diagnosis and survival outcomes is important to serve as a foundation for policy interventions. Retrospective cohort study using patients with head and neck squamous cell (HNSCC) in the Surveillance, Epidemiology, and End Results (SEER) database from 2007 to 2016 and Area Resource File. Primary outcomes included stage of presentation and cancer-specific 5-year survival and relation to provider density. The initial cohort consisted of 18 342 patients with oral cavity, 21 809 oropharyngeal, 15 860 laryngeal, and 2887 patients with hypopharyngeal malignancy. Non-Hispanic Black race and being uninsured increased the odds of presenting with advanced stage HNSCC and increased hazard of death. There was no significant and consistent association identified between Health Service Areas provider density and advanced stage at diagnosis or cancer-specific 5-year mortality. Provider density of otolaryngologists and primary care physicians and dentists was not significantly associated with stage of presentation or cancer-specific survival for HNSCC while race and insurance status remained independent predictors for worse outcomes.

Landscapes of care and despair for rural youth \u2013 a qualitative study in the northern Swedish \u2018periphery\u2019

BackgroundThis study emerges as a response to the lack of youth perspectives when it comes to discussions about access to and experiences of health and social services in rural areas. It subsequently contributes to the literature by positioning young people at the centre of this debate, and by taking a more holistic approach to the topic than is typically the case. Specifically, based on the idea that a good life in proper health for young people may be contingent on notions of care that are bounded up in multi-layered social and spatial environments, the aim of this study was to explore what characterises ‘landscapes of care’ for rural youth.MethodsIn this qualitative study, the participants included young people and professionals residing in five diverse areas across the northern Swedish ‘peripheral’ inland. Individual interviews (16 in total) and focus group discussions (26 in total) were conducted with 63 youth aged 14–27 years and with 44 professionals operating across sectors such as health centres, school health, integration units, youth clinics and youth clubs. Following an emergent design and using thematic analysis, we developed one main theme, ‘landscapes of care and despair’, comprising the two themes: ‘(dis)connectedness’ and ‘extended support or troubling gaps’.ResultsThe findings illustrate how various health-promoting and potentially harmful aspects acting at structural, organisational and interpersonal levels contributed to dynamic landscapes characterised simultaneously by care and despair. In particular, our study shows how rural youths’ feelings of belongingness to people and places coupled with opportunities to participate in society and access practical and emotional support appear to facilitate their care within rural settings. However, although the results indicate that some in the diverse group of rural youth were cared for and about, a negative picture was painted in parallel. These aspects of despair included youths’ senses of exclusion and marginalisation, degrading attitudes towards them and their problems, as well as recurrent gaps in the provision and practices of care.ConclusionsTo gain a more comprehensive understanding about the health of rural youth, this study highlights the benefits investigating ‘care-ful’ and ‘uncaring’ aspects bounded up in dynamic and multi-layered landscapes.

Influence of patient related factors on health seeking behaviours among men with lower urinary tract symptoms attending surgical outpatient clinic at Meru Level Five Hospital, Kenya

Background: Currently there are increased cases of men presenting with lower urinary tract symptoms (LUTS) especially in low resource countries. The purpose of this study was to establish the influence of patient related factors on health seeking behaviors for LUTS among men attending surgical outpatient clinic at Meru hospital, Kenya.Methods: Descriptive cross-sectional study design was used. Population involved 120 men suffering from LUTS, 2 physicians and 2 nurses. Questionnaires and interview guides were used for data collection. Study period was from August 2018 to March 2020.Results: Patients (67.0%) were aged between 61-70 years. Primary education level (68.8%). Farmers (72.0%) with income level of below Kenyan Shilling (Ksh.) 20,000. Logistic regression was used whereby p values (p≤0.05). The inferential statistics pointed out that patient related factors test items had a statistical significant influence since the p values were found to be less than 0.05 at 95% confidence interval.Conclusions: There was a significant negative influence of patient related factors such as lack of knowledge, low income levels and distance to health care facilities on health seeking practices. Patients sought medical attention when quality of their lives had been threatened. The study recommends adopting measures of rising awareness on need for seeking early medical attention and initiate outreach health services in underserved areas or through telehealth.

What works, why and how? A scoping review and logic model of rural clinical placements for allied health students

BackgroundAllied health services are core to the improvement in health outcomes for remote and rural residents. Substantial infrastructure has been put into place to facilitate rural work-ready allied health practitioners, yet it is difficult to understand or measure how successful this is and how it is facilitated.MethodsA scoping review and thematic synthesis of the literature using program logic was undertaken to identify and describe the contexts, mechanisms and outcomes of successful models of rural clinical placements for allied health students. This involved all empirical literature examining models of regional, rural and remote clinical placements for allied health students between 1995 and 2019.ResultsA total of 292 articles were identified; however, after removal of duplicates and article screening, 18 were included in the final synthesis. Australian papers dominated the evidence base (n = 11). Drivers for rural allied health clinical placements include: attracting allied health students to the rural workforce; increasing the number of allied health clinical placements available; exposing students to and providing skills in rural and interprofessional practice; and improving access to allied health services in rural areas. Depending on the placement model, a number of key mechanisms were identified that facilitated realisation of these drivers and therefore the success of the model. These included: support for students; engagement, consultation and partnership with key stakeholders and organisations; and regional coordination, infrastructure and support. Placement success was measured in terms of student, rural, community and/or program outcomes. Although the strength and quality of the evidence was found to be low, there is a trend for placements to be more successful when the driver for the placement is specifically reflected in the structure of the placement model and outcomes measured. This was seen most effectively in placement models that were driven by the need to meet rural community needs and upskill students in interprofessional rural practice.ConclusionThis study identifies the factors that can be manipulated to ensure more successful models of allied health rural clinical placements and provides an evidence based framework for improved planning and evaluation.

Can people-centered community-oriented interventions improve skilled birth attendance? Evidence from a quasi-experimental study in rural communities of Cambodia, Kenya, and Zambia

BackgroundSkilled attendance at delivery is a key marker for reducing maternal mortality. Effective community engagement strategies complemented by community health worker (CHW) services can improve access to maternal health services in areas with limited health infrastructure or workforce.MethodsA quasi-experimental study with matched comparison groups was conducted in Cambodia, Kenya and Zambia to determine the effect of integrated community investments on skilled birth attendance (SBA). In each country, communities in two districts/sub-districts received a package of community-oriented interventions comprised of timed CHW household health promotion for maternal, newborn and child health complemented by social accountability mechanisms using community scorecards. Two matched comparison districts/sub-districts received ongoing routine interventions. Data from the final evaluation were examined to determine the effect of timed CHW services and community-oriented interventions on SBA.ResultsOver 80% of the 3037 women in Cambodia, 2805 women in Kenya and 1171 women in Zambia reported SBA. Women in intervention sites who received timely CHW health promotion and social accountability mechanisms in Cambodia showed significantly higher odds of SBA (aOR = 7.48; 95% CI: 3.87, 14.5). The findings also indicated that women over the age of 24 in Cambodia, women with primary or secondary education in Cambodia and secondary education in Kenya, women from higher wealth quintiles in Cambodia, and women with four or more antenatal care (ANC) visits in all countries reported significantly higher odds of SBA. Inclusion of family members in pregnancy-related discussions in Kenya (aOR = 2.12; 95% CI: 1.06, 4.26) and Zambia (aOR = 6.78; 95% CI: 1.15, 13.9) and follow up CHW visits after a referral or health facility visit (aOR = 2.44; 95% CI: 1.30, 4.60 in Cambodia; aOR = 2.17; 95% CI 1.25, 3.75 in Kenya; aOR = 1.89; 95% CI: 1.05, 2.02 in Zambia) also showed significantly greater odds of SBA.ConclusionsEnhancing people-centered care through culturally appropriate community-oriented strategies integrating timely CHW health promotion and social accountability mechanisms shows some evidence for improving SBA during delivery. These strategies can accelerate the achievement of the sustainable development goals for maternal child and newborn health.

Quick and collaborative response to teenage pregnancies in a poor semi-rural area of Belgium

Abstract Early pregnancies are often linked to precarious situations. Even if Belgium has seen a decrease in teenage pregnancies, in the former mining region of the Hainaut there are still twice as many births to young women under 20 compared to the national rate. Colfontaine is one of the poorest cities in Belgium. Last year, one of the local high schools counted 10 pregnant teenagers out of 450 students. Médecins du Monde was already present in the city at the time with a mobile health clinic called the Médibus. In response, we carried out a mapping of the local sexual and reproductive health actors. The lack of accessibility to social and health structures capable of welcoming teenagers anonymously and free of charge quickly emerged as a problem, the nearest family planning center being located 30 minutes away by bus. In September 2019, in partnership with 5 local health actors, we decided to reshape the Médibus into the Adobus in order to offer family planning consultations, health promotion and harm reduction activities at the high school once a week. In addition to offering health information services, we also aim to detect teenagers experiencing vulnerable situations such as addiction, violence, gender issues and refer them to appropriate services. Halfway through the project, we met 430 teenagers in 14 afternoons. The most common reasons for consultation (N = 310) were questions related to contraception for 29% and to sexually transmitted infections for 24,5%. 70,9% of teenagers received condoms and 13 girls were tested for pregnancy. One girl received a morning-after pill. 3 teenagers with addiction problems and 17 victims of violence were detected. The teams referred 18 teenagers to other services. The success of this outreach project confirms the need for information regarding sexual and reproductive health for teenagers living in precarious situations as well as the need to develop reachable and affordable sexual and reproductive health services in semi-rural areas. Key messages Outreach is an efficient approach to respond to teenagers’ needs in poor semi-rural areas. Outreach facilitated the detection of early pregnancies, addiction and violence issues among teenagers.

Perception and Response to Tertiary Hospital Designation System: Focusing on the Health Service Area

Perception and Response to Tertiary Hospital Designation System: Focusing on the Health Service Area

Spatial inequities of mental health nurses in rural and remote Australia.

Despite an increased burden from chronic mental health conditions, access to effective mental health services in rural and remote areas is limited, and these services remain spatially undefined. We examine the spatial availability of mental health nurses across local government areas in Australia and identify gaps in mental health service delivery capacity in a finer-grained level than the state/territory data. A spatial distribution of mental health nurses was conducted. We utilized the 2017 National Health Workforce Dataset which was aggregated to LGA level based on the 2018 Australian Bureau Statistics (ABS) Data. The availability of mental health nurses was measured using the full time equivalent (FTE) rates per 100000 population. We calculated the proportion of LGAs with zero total FTE rates based on remoteness categories. We also compared the mean of total FTE rates based on remoteness categories using analysis of variance. A spatial distribution of mental health nurses was visualized using GIS software for total FTE rates. Our analysis included 544 LGA across Australia, with 24.8% being defined as remote and very remote. The mean total FTE for mental health nurses per 100000 populations is 56.6 (±132.2) with a median of 17.4 (IQR: 61.8). A wide standard deviation reflects unequal distribution of mental health nurses across LGAs. The availability of total FTE rates for mental health nurses per 100000 populations is significantly lower in remote and very remote LGAs in comparison with major cities. As many as 35.1% of LGAs across Australia have no FTE for mental health nurses with 46% are remote and very remote. Our study reflects the existing unequal distribution of mental health nurses between metropolitan/urban setting and rural and remote areas. We suggest three broad strategies to address these spatial inequities: improving supply and data information systems; revisiting task-shifting strategies, retraining the existing health workforce to develop skills necessary for mental health care to rural and remote communities; and incorporating the provision of mental health services within expanding innovative delivery models including consumer-led, telemedicine and community-based groups.

COVID-19 - The Availability of ICU Beds in Brazil during the Onset of Pandemic.

Background:Brazil faces some challenges in the battle against the COVID-19 pandemic, including: the risks for cross-infection (community infection) increase in densely populated areas; low access to health services in areas where the number of beds in intensive care units (ICUs) is scarce and poorly distributed, mainly in states with low population density.Objective:To describe and intercorrelate epidemiology and geographic data from Brazil about the number of intensive care unit (ICU) beds at the onset of COVID-19 pandemic.Methods:The epidemiology and geographic data were correlated with the distribution of ICU beds (public and private health systems) and the number of beneficiaries of private health insurance using Pearson’s Correlation Coefficient. The same data were correlated using partial correlation controlled by gross domestic product (GDP) and number of beneficiaries of private health insurance.Findings:Brazil has a large geographical area and diverse demographic and economic aspects. This diversity is also present in the states and the Federal District regarding the number of COVID-19 cases, deaths and case fatality rate. The effective management of severe COVID-19 patients requires ICU services, and the scenario was also dissimilar as for ICU beds and ICU beds/10,000 inhabitants for the public (SUS) and private health systems mainly at the onset of COVID-19 pandemic. The distribution of ICUs was uneven between public and private services, and most patients rely on SUS, which had the lowest number of ICU beds. In only a few states, the number of ICU beds at SUS was above 1 to 3 by 10,000 inhabitants, which is the number recommended by the World Health Organization (WHO).Conclusions:Brazil needed to improve the number of ICU beds units to deal with COVID-19 pandemic, mainly for the SUS showing a late involvement of government and health authorities to deal with the COVID-19 pandemic.

Compliance with thyroid nodule ultrasound reporting guidelines in an Australian Area Health Service

Compliance with thyroid nodule ultrasound reporting guidelines in an Australian Area Health Service

Barriers to access and organization of primary health care services for rural riverside populations in the Amazon

BackgroundThe ways of life in the Amazon are diverse and not widely known. In addition, social inequities, large geographic distances and inadequate health care network noticeably limit access to health services in rural areas. Over the last decades, Brazilian health authorities have implemented fluvial mobile units (FMU) as an alternative to increase access and healthcare coverage. The aim of the study was to identify the strategies of access and utilization of primary health care (PHC) services by assessing the strengths and limitations of the healthcare model offered by the FMU to reduce barriers to services and ensure the right to healthcare.MethodsQualitative and ethnographic research involving participant observation and semi-structured interviews. Data collection consisted of interviews with users and health professionals and the observation of service organization and healthcare delivered by the FMU, in addition to the therapeutic itineraries that determine demand, access and interaction of users with healthcare services.ResultsPrimary care is offered by the monthly locomotion of the FMU that serves approximately 20 rural riverside communities. The effectiveness of the actions of the FMU proved to be adequate for conditions such as antenatal care for low-risk pregnancy, which require periodic consultations. However, conditions that require continued attention are not adequately met through the organization of care established in the FMU. The underutilization of the workforce of community health workers and disarrangement between their tasks and those of the rest of the multi-professional team are some of the reasons pointed out, making the healthcare continuity unfeasible within the intervals between the trips of the FMU. From the users’ perspective, although the presence of the FMU provides healthcare coverage, the financial burden generated by the pursuit for services persists, since the dispersed housing pattern requires the locomotion of users to reach the mobile unit services as well as for specialized care in the urban centers.ConclusionsThe implementation of the FMU represents an advance in terms of accessibility to PHC. However, the organization of their activity uncritically replicates the routines adopted in the daily routine of health services located in urban spaces, proving to be inadequate for providing healthcare strategies capable of mitigating social and health inequalities faced by the users.

Developments in Electronic Nursing Logbooks in Health Service Areas: Literatur Review

Background: Efforts to reduce the impact of the logbook vacancy and facilitate nurses in documentation in the industry 4.0 era have been developed with electronic logbooks (E-logbooks) used for more accurate documentation and assessing performance based on the achievement of individual utility activities. . The electronic logbook (E-logbook) of nurses is designed to be a documentation that records the achievement of activities, nurses' skills, and updates all activities, such as Continuous Professional Development (CPD), and is used in assessing employee behavior for 1 (one) year . Purpose: Make a summary and analysis of articles related to the nurse's Electronic logbook (E-logbook). Methods : Literature review is done by making a summary and analysis of the article. The method of searching articles in the literature review uses several electronic databases, namely Google Scholar, PubMed, JHA Science Direct, CINAHL, and ProQuest with the keywords electronic logbook nursing. The impact of the Elcetronic logbook on individual performance assessments that reflect staff competencies and performance and is carried out objectively and transparently so that the potential also increases the motivation of clinical staff which can lead to increased productivity and quality of health service. Results: Nurse e-Logbook has an important role, namely as evidence of documentation of the implementation of activities and clinical supervision . Conclusion: In Indonesia, only a small portion of health services, which already uses an electronic logbook program.

Improving and standardizing metabolic screening for people prescribed antipsychotic medication who are at risk of developing metabolic syndrome within the community mental health setting.

Aim and objective of the audit. The purpose of this audit was to identify the number of people prescribed antipsychotic medication who are at risk of developing metabolic syndrome in a community mental health service area with the aim of improving and standardising metabolic screening practices within this setting. Community mental health services are secondary care services in which individuals are referred from Primary Care (General Practitioners). The catchment area of this audit is within the South East Region of Ireland and offers adults community mental health services to a population of approximately 57000. For the purpose of this audit we focused on one community mental health team within the service.

EVALUASI DAN STUDI PERSEPSI TERHADAP TINGKAT PELAYANAN JALUR PEJALAN KAKI KAWASAN PENDIDIKAN

Ade Irma Suryani street is one of the area in Payakumbuh city that is designed as an area which mainly function as educational and others such as offices and health service area. Educational infrastructure on this street includes Public Primary School 04 Payakumbuh, Raudhatul Jannah Payakumbuh Islamic Middle School, Campus II Andalas University Payakumbuh and PAUD Bakti Pediatrics. Educational, offices and health service infrastructure encourage the society to use the pedestrian pathways. The existing condition of infrastructure and facilities are still considered inadequate with various problems. This research aim to evaluate the level of service of pedestrian pathways, to review public perception of pedestrian pathways service, and to set the primary variable for the enhancement of pedestrian pathways based on user perception. The quotation of the level of pedestrian service is based on Minister of Public Works Regulation Number: 03/PRT/M/2014. Characteristic analysis result stated that the level of service on the north side is regarded as “A”. While the level of service on the south side is regarded as “B”. Public perception analysis of pedestrian pathways service is carried using the Importance Performance Analysis (IPA) method, with 6 research variable namely accessibility, safety, comfort, aestethic, convenience and social interactions. The result of the analysis stated that the primary priorities are accessibilty, aesthetic, convenience and social interactions, the variable which need maintance in it’s performance is safety and the variable which considered excessive is comfort.

The pink vans: Bringing cancer screening closer to home.

e14021 Background: A global survey reported that among 15 Asian countries, the Philippines has the highest breast cancer mortality rate and the lowest mortality-to-incidence ratio. This may be due to the fact that majority of breast cancers are diagnosed in locally advanced or metastatic stages among low- and middle-income countries. Studies show that in the Philippines more than half (53%) of patients with breast cancer were diagnosed at stages III and IV, while only 2-3% of cases were treated at Stage I. This translates to a dismal 58.6 % 5-year survival rate. Furthermore, socioeconomic factors were identified as one of the major causes for the lack of access to early detection and treatment. These include lower educational level, higher poverty rates, inadequate or no health insurance, lack of transportation, and/or the unavailability of health services in far-flung areas. These findings are currently of urgent national concern since the improvements in breast cancer survival rates brought by advances in treatments are mainly dependent on early detection, screening and timely treatment. Methods: In response to this gap in the delivery of services to promote early cancer detection, the University of the Philippines – Philippine General Hospital (UP-PGH) Cancer Institute established the Mobile Breast Cancer Diagnostic Clinic Program, a first in the country where two fully equipped “pink” vans are sent out to far flung areas and provide breast cancer screening and diagnostic services (eg. Mammogram, breast ultrasound, biopsies of suspicious masses, etc). These vans are manned by medical and surgical oncologists, and various paramedical professionals. Results: In the first 6 months of the program, the “pink” vans were able to visit 3 strategically identified areas in the country. These three tours have served a total of 189 women who all underwent screening mammography. 18 had their suspicious lesions biopsied, and two-thirds of which were found to be malignant. These patients were then referred to our institution for further work-up and management. Conclusions: As the Philippine health department continues to emphasize clinical and self-breast exam as part of its breast cancer control program, efforts like the UP-PGH “Pink Vans” may eventually help supplement the gap in the country’s breast cancer screening endeavors with the goal of improving survival by identifying the disease at its earliest stage.

PIH37 INEQUALITY OF OPPORTUNITY IN MATERNAL HEALTH AMONG ADOLESCENTS

Adolescent maternal health remains a major public health and economic burden to Kenya, with maternal morbidity and mortality being highest among adolescent mothers. The Government of Kenya has adopted several policies to improve maternal health, however, demand for these services remain less than optimal. Studies shows that circumstances beyond the adolescence like stigma and discrimination, parental socioeconomic status etc influence utilization of health services. The objective of this study was to estimate inequality of opportunity (IOp) in maternal health among the adolescence ages 15-19 year in Kenya and estimate percentage contribution of each circumstance to IOp. Three waves of pooled Kenya Demographic Health Survey (KDHS) data for 2003, 2008/09 and 2014 were used in the study. This study used Human Opportunity Index (HOI) to examine the equality of opportunity three adolescent maternal health service (i) Antenatal care (ii) facility delivery (iii) skilled birth attendant (iv) ever pregnant. In addition, the Shapley decomposition method was used to capture the contribution of each circumstance to inequality of these opportunities. The percentage of adolescent girls who had ever been pregnant were 18%, those who sought ANC care, delivered in the facility and received post-natal care were 53%, 71% and 60% respectively. The inequality measured by dissimilarity index (D) was lowest among adolescent facility delivery (11.1%) and highest among ever pregnant (20.24%). The opportunities for access to these services also varied ranging from 14% for ever pregnant to 62.4% for facility delivery. Wealth Status, education and location were the major contributors to IOp. To ensure all women access their socioeconomic rights including reproductive health as stated in the Kenyan Constitution and achieve universal health care, the government of Kenya needs to address the causes of IOp including increased access to education, improved health services in rural areas and reduction of poverty.

Modeling Poliovirus Transmission in Borno and Yobe, Northeast Nigeria.

Beginning in 2013, multiple local government areas (LGAs) in Borno and Yobe in northeast Nigeria and other parts of the Lake Chad basin experienced a violent insurgency that resulted in substantial numbers of isolated and displaced people. Northeast Nigeria represents the last known reservoir country of wild poliovirus (WPV) transmission in Africa, with detection of paralytic cases caused by serotype 1 WPV in 2016 in Borno and serotype 3 WPV in late 2012. Parts of Borno and Yobe are also problematic areas for transmission of serotype 2 circulating vaccine-derived polioviruses, and they continue to face challenges associated with conflict and inadequate health services in security-compromised areas that limit both immunization and surveillance activities. We model poliovirus transmission of all three serotypes for Borno and Yobe using a deterministic differential equation-based model that includes four subpopulations to account for limitations in access to immunization services and dynamic restrictions in population mixing. We find that accessibility issues and insufficient immunization allow for prolonged poliovirus transmission and potential undetected paralytic cases, although as of the end of 2019, including responsive program activities in the modeling suggest die out of indigenous serotypes 1 and 3 WPVs prior to 2020. Specifically, recent and current efforts to access isolated populations and provide oral poliovirus vaccine continue to reduce the risks of sustained and undetected transmission, although some uncertainty remains. Continued improvement in immunization and surveillance in the isolated subpopulations should minimize these risks. Stochastic modeling can build on this analysis to characterize the implications for undetected transmission and confidence about no circulation.